New threats for pediatric respiratory health: beware of vaping

Electronic cigarette (EC) was proposed on the market about 15 years ago as a harmless alternative to traditional combustion cigarettes (CC). Since then, EC and other electronic devices that deliver nicotine by simulating traditional smoking without combustion have achieved unexpected success, with around 80 million users worldwide by 2023. Such devices are commonly felt to be safer than CC, especially among adolescents, who are also the main target for aggressive marketing from the tobacco industry. Increasing evidence shows that e-liquids and vape contain toxicants and irritants and that acute and chronic vaping causes airway inflammation and bronchoconstriction and reduces responses to infections. Moreover, some studies have shown that second- and third-hand smoke, as well as in utero exposure, may cause detrimental effects to the airways and to health in general. Notably, the recent E-cigarette or Vaping use-Associated Lung Injury (EVALI) epidemic in the USA has shown that EC has higher acute toxicity than CC, while long-term effects are still not known. Since adolescents and children are often completely unaware of the health risks associated with vaping or of the potential presence of nicotine in e-liquids, pediatricians play a crucial role in educating them, in order to prevent vaping, as well as smoking. Pediatricians should always consider the possibility of vaping as the cause of unusual respiratory diseases, especially in adolescents. This narrative review paper briefly outlines the most recent data on EC and their effects on the airways, focusing on childhood and adolescence.